PSYCHOSOCIAL ISSUES
Patients with CUP experience a unique set of psychosocial issues. The unlikelihood of ever locating a primary source of the carcinoma must be expressed to patients at the initial office visit. Clinicians must consider that patients are likely to be extremely anxious about having a disease with an elusive origin. With many cancer diagnoses, patients are able to find a network of support. For example, breast cancer awareness in the community provides opportunities for raising money for research, family members understand the disease, and a pink ribbon symbolizes the disease. However, this type of community support is not available for patients with CUP and their families. Patients feel frustrated that no specific indications for screening exist for their children, and many of their family members have great difficulty understanding the diagnosis.
Decisions regarding treatment options are an additional source of anxiety. Physician assistants need to reassure the patient with CUP that the disease is treatable, even if the primary tumor is not identified. They should explain that indications from pathology and imaging studies and the physical examination can help clinicians to develop a treatment plan. Empathetic and ongoing direct communication helps build a sense of confidence in the treatment recommendations. Patients with disseminated CUP must understand the palliative nature of disease management. The health care team should set realistic goals that enhance quality of life.
CONCLUSION
Patients presenting with CUP should undergo an appropriate, directed search for a primary tumor. Clinicians must take into account clinical, diagnostic, and pathologic information when determining the most appropriate treatment plan. The cornerstone of treatment is double cytotoxic agents (platinum-based agents). Immunohistochemical stains and advancements in molecular profiling are allowing clinicians to tailor treatment plans to the patient's specific tumor biology, resulting in better outcomes. JAAPA
Heather Carlson works in the Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston. She has indicated no relationships to disclose relating to the content of this article.
DRUGS MENTIONED
Carboplatin (Paraplatin, generics) Etoposide
Octreotide (Sandostatin, generics)
Paclitaxel (Abraxane, Taxol, generics)
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